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It is challenging enough to ensure compliance with Medicare billing rules within your own organization, but don't forget that you also can be drawn into someone else's scam. Federal authorities are cracking down on billing fraud that originates outside your hospital, and if you aren't careful, you can be caught up in the prosecution, with all the attached liability.
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Risk managers are obligated to take the proper steps to detect fraudulent activity and to avoid becoming a naive conspirator, says Steve Lee, an investigator with Steve Lee & Associates, a forensic accounting and litigation consulting firm in Los Angeles. He has consulted on a number of high-profile fraud cases and says risk managers can reduce their vulnerability to billing scams with a few simple precautions.
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As if the False Claims Act (FCA) wasn't already enough of a headache for risk managers, recent changes to the law could bring even more reason to worry. Risk managers should be aware of how the Fraud Enforcement and Recovery Act of 2009 (FERA) will affect them, says Richard Glovsky, JD, a partner with the Boston-based law firm Prince Lobel.
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Lean management techniques helped Lahey Clinic Medical Center, North Shore, in the city of Peabody, MA, boost patient satisfaction and reduce emergency department (ED) waiting times.
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News: A woman presented at a hospital emergency department with complaints of headaches, blurry vision, and shortness of breath. Her work-up included a CT scan of her head, chest X-rays, and routine blood tests.
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The latest iteration of the DHHS guidelines was released December 1, 2009. The major changes to previous versions of the guidelines include a number of changes listed below:
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Since April 2009, pandemic influenza a (H1N1) virus isolates have been tested for resistance to adamantanes (amantadine, rimantadine) and have demonstrated 100% resistance to this class of antiviral agents.
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In 2003, the american academy of orthopedic surgeons (AAOS) and the American Dental Association jointly published recommendations regarding antibiotic prophylaxis for dental patients who had had total joint replacements.
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In this issue: Statin and niacin increase HDL-C, omeprazole reduces effectiveness of clopidogrel, darbe-poetin increases risk of stroke, statins decrease risk of gallstone disease, FDA Actions.
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